Provider Demographics
NPI:1851451405
Name:STEPHENS, JAMES A (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1713
Mailing Address - Country:US
Mailing Address - Phone:850-893-4005
Mailing Address - Fax:850-893-9987
Practice Address - Street 1:1480 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1713
Practice Address - Country:US
Practice Address - Phone:850-893-4005
Practice Address - Fax:850-893-9987
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19482OtherBLUE CROSS BLUE SHIELD
FLT83939Medicare UPIN
FL19482Medicare ID - Type Unspecified